Exam 2

Question 1

is a hemorrhage of blood between the skull and the periosteum (outer layer of bone) of any age human, to rupture of blood vessels crossing the periosteum.

Or

is a traumatic subperiosteal haematoma that occurs underneath the skin, in the periosteum of the infant’s skull bone

A collection of blood between the periosteum of a skull bone and the bone itself

Answer 1

Cephalohematoma

Question 2

One leg longer, extra skin folds on inner thigh , uneven gluteal folds, hip click maneuver

Answer 2

Congenital hip dysplasia

Question 3

Cleft lip- what it is?

Feedings?

Education for parents ?

Safety precautions?

Answer 3

Fissure or opening in the upper lip

The result of failure of maxillary and medium nasal processes

Can be fixed with surgery - encourage them to fix it to improve speech, dental , feedings, positive self image

Feedings- by dropper until the wound is completely healed 1-2 weeks . Breast fed milk or formula as soon as clear liquids are tolerated

Safety- auctioning the mouth should be avoided in infants who have a cleft palate repair

Question 4

What is presumptive pregnancy?

Signs?

Answer 4

Definite diagnoses of pregnancy.. can’t be made.. signs could be common during pregnancy but can indicate something else

Deepening pigmentation, urinary frequency, quickening(moving of baby), amenorrhea (late period) Period late, tired , breast are tender, nauseated.

Question 5

Define primigravida ?

Answer 5

Someone who is pregnant for the first time

Question 6

What is viability of fetus?

Answer 6

The gestational age at which a prematurely born fetus/ infant had 50% chance of long term survival outside the womb

24-25 weeks

Question 7

How often should women make prenatal visits ?

Answer 7

Weeks 4-8: 1 prenatal visit a month

Weeks 28-36: 1 prenatal visit every two weeks

Weeks 36-40: 1 prenatal visit every week

Question 8

Define supine hypotension ?

Signs/symptoms?

What to do/nursing intervention?

Answer 8

Feeling of sickness and low bp that Occurs when pregnant women lie on their back

May feel dizzy/weak, low bp, nausea, sweating, pallor (pale), tachycardia

Turn patient to left side to resolve

Question 9

Teachings for pregnant women traveling far from home ?

Answer 9

Take plenty of rest breaks

Drink plenty fluids

Not recommended after third trimester

Check with airlines if they have cut off when pregnant women can fly

Prenatal records

Seatbelt below abdomen

Question 10

Signs and symptoms of “true labor”?

Answer 10

With true labor contractions, they become stronger, closer together and more regular

Question 11

Normal fetal heart tones ?

When to report?

Answer 11

110-160 bpm

Heard through Mother’s abdominal wall

Report anything under or higher heart rate

Question 12

What is Gravita and Para status ?

Answer 12

Gravita - number of pregnancies

Para - number of births after 20 weeks

Question 13

What makes up a normal umbilical cord?

Answer 13

AVA- Artery vein Artery

2 arteries and one vein

Question 14

Nurses priority during labor and delivery?

Pg 183
Pg 197

Answer 14

? Preparing for delivery
Asses for abnormalities
Promote bonding

Fetal assessment/VS/HR
Labor process
Maternal and fetal tolerance to labor 
Pain management 
I and O
Vitals
Communication with MD
Empty bladder 
Promote position changes 
Provide hygiene 
Support and encouragement 
Assist with breathing techniques

Question 15

Normal location of zygote implantation ?

Answer 15

Upper section of the posterior uterine wall

Question 16

How to figure out Nagels rule ?

Answer 16

First day of last normal period
Subtract 3 months
Plus 7 days
Correct the year if necessary

Question 17

Interventions and education for nausea and vomiting during pregnancy ?

Answer 17

Dry carbs like saltine crackers , lemonade over ice , sea bands , small frequent , and non-greasy meals

Question 18

Normal weight gain during pregnancy and education?

If under weight ?

If overweight ?

Answer 18

25-35 pounds

Healthy nutrition, take vitamins, exercise, watch weight

28-40

11-25

Question 19

Intrauterine growth restriction

Causes

Treatment

Answer 19

A condition in which a baby doesn’t grow to normal weight during pregnancy

Problem with placenta (common cause)

or health problems such as diabetes , HTN, heart disease, infections, kidney/lung disease, anemia, malnutrition, smoking , alcohol, drugs , chromosomal defects

Regular dr apts , be aware of body movements, check meds , eat healthy nutrition, plenty of rest, stop smoking

Question 20

How to measure frequency of normal contractions ?

Labor vs false labor?

Answer 20

Frequency: Time from the beginning of one contraction until the beginning of the next (minutes)

Duration: time from the beginning of a contraction until the end of the same contraction (seconds)

Braxton Hicks- false labor where contractions can be regular or irregular, practicing for labor , does not cause a change in cervix

Real labor - regular rhythmic contractions, cervix changes , bloody discharge, water breaks

Question 21

Nursing interventions for back labor pain?

Answer 21

Put woman on hands and knees , lean forward , birthing ball

Question 22

What is back labor ?

Answer 22

Pain or discomfort in lower back, just above tailbone , to a woman during childbirth

Question 23

Progression of labor ?

What is normal and what can cause it to slow?

Answer 23

1st :

Latent phase - slow effacement of the cervix , longest phase , 0-3 cm

Active phase- best time for pain meds epidural, 4-8 cm

Transition phase- angry sweaty, 9-10 cm

2nd- pushing / deliver
3rd-delivery of placenta
4th- bonding-put on belly and breast feed

Can slow- Stress, worry, fear , full bladder

Question 24

What is amniotomy ?

What is the reason it’s done ?

Answer 24

Breaking amniotic fluid/ water

Done to induce or expedite labor

Question 25

Normal color of amniotic fluid? What to report immediately?

Answer 25

Clear with flecks of white vernix Green fluid is also normal and means that hey have passed meconium ( their first stool) Report- cloudy or yellow fluid with a bad odor- it might indicate an infection.

Question 26

Foods high in iron?

Answer 26

Fish, green leafy veggies , red meats

Question 27

What is the fundus?

Answer 27

The upper part of the uterus - which is broad and flat -where Fallopian tubes enter on each side

Question 28

The distance from the pubic bone to the top of the uterus

Answer 28

Fundal height After 20 weeks your fundal height should match the number of weeks you been pregnant in cm

Question 29

Fundal height at each trimester ? Assessment after delivery? Possible reasons for abnormalities ?

Answer 29

3rd trimester grow 1 cm per week Asses 1 hour after Delivery to check if fundus is firm and at the level of the umbilicus- massage Pain/contractions to normal size, bleeding, Check for clots , boggy uterus can be a sign of hemorrhage that needs to be treated STAT

Question 30

Nurses priority on the newborn?

Answer 30

? Examine head for lacerations, abrasions , or bruising

Question 31

Pain assessment after delivery ?

Answer 31

Vaginal hematoma Pelvic or rectal pain -Cold pack in area , analgesics

Question 32

Security process between mom and newborn?

Answer 32

No one but mom can carry baby to and from nursey Anyone carrying must have badge ID Any not mom push in crib

Question 33

Normal vitals of new born?

Answer 33

BP- 60-80/40-45. (64/41) Resp- 40-60 Heart rate - 110-160 T-96.8-99.0

Question 34

Assessment findings for post term infant (born after 42 weeks)?

Answer 34

Wrinkled skin LGA (large macromonia) or long and thin ^Hypoglycemia Meconium staining Long nails Peeling skin

Question 35

What complications to look for with forceps delivery?

Answer 35

Trauma : laceration , hematoma, bruising

Question 36

Newborn assessment to report?

Answer 36

Vs abnormalities Apgar number Gestational age Anomalies or skin conditions or jandauce - report if any STAT Reflexes

Question 37

What are (pitocin) Oxytocin infusions used for? When are they stopped ? Assessment during infusion ? Possible complications?

Answer 37

Oxy- strengthen contractions To contract the uterus Stop IV when it induces labor and notify provider - 2-3 min apart Asses time of contraction and placenta - Excessive bleeding , abnormal heart rate , HTN, seizures, shallow breathing, muscle cramps

Question 38

Nursing intervention with a stillborn ?

Answer 38

Therapeutic communication (silence, sympathy, open ended statements, reflection) Promote expression of grief by providing privacy, eliminating time restrictions, allow support visits , recognition of cultural norms for grief/loss

Question 39

What is phototherapy used for ? Nursing actions?

Answer 39

Used to treat jaundice - get rid of excess bilirubin ``` Keep eyes covered Hydrate Frequent feeding Expose skin as much as possible Reposition every two hours or more Monitor bilirubin levels in blood Involve parents ```

Question 40

Swelling during pregnancy - what it indicates? Education Primary assessments?

Answer 40

Preeclampsia /edema Teach the symptoms, mag sulfate May cause hot flash, keep room quit and dim to prevent seizure watch BP, hourly vitals , urine output 30 ml or more , magnesium levels, 24 hour urine sample, CBC , respiration depression, DTR (deep tenden reflexes) , seizures

Question 41

Gestational hypoglycemia- Signs and symptoms ? Priority assessment?

Answer 41

Linked to women taking insulin or medicine for bs Shaking and tremors , immature lungs, macrosomnia in baby, check for glucose and ketones

Question 42

Kick count education?

Answer 42

After 28 weeks, it’s ok if no movement in 30 minutes Needs to be 10 times in 2 hours

Question 43

Difference between reactive and nonreactive stress test?

Answer 43

Reactive: Two or more fetal heart accelerations within 20 minute period with or without fetal movement. Baby’s heart rate above baseline 15x Non reactive : fetal heart rate did not go up (nothing)

Question 44

Enlarged , gnarled veins commonly in the legs and feet

Answer 44

Varicose veins

Question 45

Signs and symptoms of varicose veins ? Nursing education ?

Answer 45

Aches and pain , dark purple veins , burning , throbbing, muscle cramping and swelling in lower legs , itching , bleeding, color changes, hardening, inflammation of skin or ulcers near ankle Avoid standing or sitting for long periods Walk/ exercise Rest with legs elevated Compression stockings Avoid tight knee highs Relieve hemorrhoid swelling with warm sits bath, pain ointment

Question 46

Functions of the placenta ?

Answer 46

Delivers nutrients to baby, removes CO2 and waste

Question 47

Placenta previa - what is it? signs and symptoms ?

Answer 47

When placenta covers the opening of the mothers cervix Painless bright red bleeding

Question 48

Abrupt decrease in fetal heart rate and decrease baseline? Can happen with umbilical cord is temporary compressed

Answer 48

Variable decelerations

Question 49

Bonding after delivery ?

Answer 49

Out baby on mother’s chest The newborn should breast feed with in the first hours when alert Postpartum interferes Immediately - postpone cream

Question 50

Pre-eclampsia/Eclampsia- priority nursing interventions?

Answer 50

Preeclampsia- renal involvement leading to proteinuria . HTN , edema , and protein in urine during pregnancy Eclampsia- CNS involvement causing seizures, liver and coagulation abnormalities dominate the clinical picture Monitor urine protein (3+ may indicate proteinuria) Monitor weight ,urine output less than 30 ml ,baseline vital signs , fetal hr , minimal stimulation, edema , fluid intake and output Calcium gluconate reverses magnesium sulfate Blood pressure and seizure meds

Question 51

Treatment for perineal lacerations after delivery?

Answer 51

? Assessed for normal healing and signs of complications Cold packs before first 12 hours to reduce pain, bruising , edema 12-24 hours after- heat packs or sitz baths increase blood circulation for healing Oral pain meds

Question 52

Developmental milestones

Answer 52

Birth -3 months - cooing and interacting 4-6 months- interests in sounds - balance self, sit up , tripid 7-8 months - waving / gestures , sit alone 9months - walk by a year, fear of strangers

Question 53

Probable signs of pregnancy ?

Answer 53

Goodelles sign, Chadwick’s sign , hegars sign, McDonald’s , abdominal enlargement , Braxton Hicks , ballotment , straie, positive pregnancy test

Question 54

Positive signs of pregnancy?

Answer 54

Audible fetal heartbeat Fetal movement felt by examiner Ultrasound visualization of fetus